Freakonomics Radio: Gambling With Your Life — or: Why Las Vegas is the Suicide Capital of the U.S.

Suicide city: Las Vegas has the highest metropolitan suicide rate in the country (Photo: Hemera)

One of the upcoming hour-long Freakonomics Radio shows we’re currently producing (which will be heard on public-radio stations across the country, not just in the podcast stream) is about suicide. It’s hard to pinpoint the thesis — perhaps we don’t quite have one — but there are any number of interesting things to know about the problem, and ways to think about it.

The single most surprising fact to me is that suicides are more than twice as numerous in this country as homicides. Some questions that naturally arise from this fact: where are suicides most prominent, and among whom, and why?

Freakonomics Radio

”Gambling With Your Life”: Does Las Vegas increase your risk of suicide? A researcher embeds himself in the city where Americans are most likely to kill themselves.

To that end, we’ve just put out a new podcast (you can download/subscribe at iTunes, get the RSS feed, listen live via the link in box at right below, or read the transcript here) about suicide in Las Vegas, which has the highest metropolitan suicide rate in the U.S. The podcast features an interview with Matt Wray, a sociologist at Temple who studies, as he puts it, “losers.” (Trust me, he doesn’t use the word lightly, or disparagingly.) Wray is the author of Not Quite White: White Trash and the Boundaries of Whiteness and co-author of a 2008 paper called “Leaving Las Vegas: Exposure to Las Vegas and Risk of Suicide” (online here, download here):

Residents of Las Vegas, Nevada have much higher suicide rates than residents of other metropolitan counties in the USA. Whether the risk of suicide among visitors to Las Vegas is also significantly elevated has been difficult to assess because person-time denominator information is not available. We used a case–control design to examine the association between exposure to Las Vegas and risk of suicide expressed as mortality odds ratios. We conceptualized four different types of potential suicide risk with respect to Las Vegas: (1) risk of suicide among usual residents of Las Vegas (‘‘chronic risk’’), (2) risk of suicide among temporary visitors to Las Vegas (‘‘acute risk’’), (3) risk of suicide among Las Vegas residents visiting elsewhere (‘‘leaving Las Vegas risk’’), and (4) risk of suicide among travelers in general (‘‘traveler risk’’). Controlling for age, gender, marital status, and year effects, the odds of suicide among Las Vegas residents was at least 50% greater than among residents elsewhere in each of the three decades we observed. Visitors to Las Vegas were at double the risk compared to those who stayed in their home county. Leaving Las Vegas was associated with a greater than 20% reduction in risk for suicide. Traveling to Las Vegas is associated with a twofold increase in risk compared to traveling elsewhere. We discuss three possible theoretical frameworks to help explain our observed results: ecological effects, whereby social factors unique to Las Vegas, or uniquely amplified in Las Vegas, result in increased risk to both residents and visitors; selection effects whereby those predisposed to suicide disproportionately choose Las Vegas to reside in and visit; and contagion effects, whereby high numbers of suicides tend to lead to even greater numbers over time, as people emulate the suicides of others. We compare our empirical evidence for each of the effects with existing sociological and historical scholarship on Las Vegas.

Temple sociologist Matt Wray

In the podcast, we discuss Wray’s motivation, methodology, and his thinking about causal factors. Some excerpts:

I was living in Las Vegas and I wanted to understand more about Las Vegas as a community. I’d just moved there and was struck by the exceedingly high suicide rate in Las Vegas. So, I wanted to know what’s causing this, and more specifically could it be something about the place that actually is effectively sort of suicidogenic. You know, what’s generating this high rate of suicide over such an extended period of time? Because as far back as I could go in the statistics for decades I was seeing this consistently high rate. So it was a puzzle really that more than anything else, a curiosity that led me down this road.

And:

So the story here, and this was the famous sociologist Emile Durkheim’s point at the end of the nineteenth century, that suicide, rather than being a story about the individual’s struggles, is telling us something about society and social groups that we ought to listen to. … I think that we’re kind of schizophrenic about suicide, which is that we have both devoted — intellectuals, and scholars, and public-health officials, and sociologists, and especially psychiatrists and psychologists — have devoted so much ink to thinking, and talking, and exploring suicide that it’s hard to say that it’s, that it’s under-examined. We also tend to be obsessed with suicides in pop culture.

And:

We do seem to be far more focused on that form of violence than the lethal self-directed violence that is suicide. And I think that there’s a way in which the need for justice that we feel when a homicide occurs motivates us to take a greater collective interest in it. A crime has occurred, the most heinous kind of crime has occurred, a life has been taken, someone did it, that person is bad, we need to identify that person, and we need to bring about some justice and some retribution. Those ingredients are really missing, they’re really missing with suicide. We see it as tragedy; we see it as loss. It’s deeply saddening, and depressing, and grim, very, very grim. And so, I think it doesn’t mobilize people in the same way that homicide mobilizes people, or even in some ways accidents.

Our hour-long program on suicide isn’t quite done, so if there’s something you’re particularly interested to know, please say so in the comments section below.

Audio Transcript

Gambling With Your Life

Matt WRAY:I’m Matt Wray, and I’m a sociologist at Temple University. And I study the sociology of race and ethnicity, and I study cultural sociology. And I study medical sociology, and sort of the sociology of health and illness.

Stephen J. DUBNER: And lately at least, or in part of what you study, I know that you’ve been studying suicide as well. Correct?

WRAY:I have. To sum up what I do in a word would be to say that I study losers. And I am interested in those who lose out on societal gains and opportunities. It’s another way of saying I’m interested in inequalities and stratification.

[MUSIC]

ANNOUNCER: From WNYC and APM: American Public Media, this is Freakonomics Radio. The podcast that explores the hidden side of everything. Here’s your host, Stephen Dubner.

DUBNER: If you had to guess, would you say that more people in the U.S. die from homicide or from suicide? I mean, homicide is certainly a lot noisier in the newspaper headlines, in the cop shows on TV. But the fact is that there are more than twice as many suicides every year -- about 36.5 thousand suicides versus about 16.5 thousand homicides. And more people kill themselves in the Western states than in any other part of the country. The sociologist Matt Wray is studying this so-called “suicide belt.” He has also written a paper about one place out west that boasts the dubious distinction of having the highest suicide rate of any city in the country.

WRAY: “I was living in Las Vegas and I wanted to understand more about Las Vegas as a community. I’d just moved there and was struck by the exceedingly high suicide rate in Las Vegas. So, I wanted to know what’s causing this? And, more specifically, could it be something about the place that actually is effectively sort of suicide-ogenic. You know, what’s generating this high rate of suicide over such an extended period of time? Because as far back as I could go in the statistics for decades I was seeing this consistently-high rate. So it was a puzzle, really, that more than anything else, a curiosity that led me down this road.

DUBNER: Talk to me about the paper, what you found, what was particularly noteworthy, and surprising to you.

WRAY: The suicide rate in Las Vegas is the highest of the large cities in the United States, and it’s high by far. The suicide rate, and here this is sort of adjusting for age, is, over the period, the most recent eight years for which we have data, eighteen point four per hundred thousand people. That number in itself is meaningless, but the next highest number is in Florida, that’s fifteen point nine, fifteen point five. The national average, which is perhaps the most meaningful comparison for that same period was nine point five. So, you’re talking about a suicide rate, in a city, and cities in the United States typically have low suicide rates compared to rural areas. You’re talking about a city that has an average suicide rate which is twice the national average.

DUBNER: And the U.S. is not among the highest countries in the world in terms of suicide rate, not among the lowest either, although we actually do all right. But if we were looking at just Las Vegas, if all of the U.S. were like Las Vegas, we would then be comparable to what countries in terms of suicide rate?

WRAY: We would be comparable to countries like uh Japan, which is recognized as having a high suicide rate. We would be comparable to Austria, which is recognized as having a high suicide rate. But we wouldn’t be as high as Hungary. We wouldn’t be as high as Lithuania. We wouldn’t be anywhere near as high as Russia. These are sort of the world leaders in suicide risk.

DUBNER: All right, so walk me through the paper a little it, especially the way you tease apart different pieces of it. In other words, you looked at and wanted to tease apart the questions of whether it’s people who live and stay in Las Vegas who kill themselves. Whether it’s people who live elsewhere and come to Las Vegas and kill their selves, themselves. If people who live in Las Vegas have a higher rate than elsewhere what happens when those people go elsewhere, and so on. In other words, trying to separate, trying to tease out the effect of the place itself. So, talk me through your intentions, and then your results there.

WRAY: Right, so we really were interested in this question of what happens when you expose people to Las Vegas? Is there a way in which we can determine if there’s a "place effect" on suicide rates rather than a sort of "people effect." That is, people sort of bringing their suicide risk with them to Las Vegas. We wanted to see instead if something happened to people who were exposed to Las Vegas. And that’s true both from residents -- people who live and die in Las Vegas, and visitors, that is people who live elsewhere, but die in Las Vegas. Remember we’re just looking at dead people here. We’re just looking at death records because that’s the data that we have.

DUBNER: And what you find then is that if I live and stay in Las Vegas, I’m going to be more likely to kill myself. If I live elsewhere and travel to Las Vegas, I will be more likely to kill myself. But, if I live in Las Vegas and leave, I will be less likely to kill myself. Is that right?

WRAY: That’s correct. These are quite different-sized effects. If you, what we call the chronic exposure model. If you live and are chronically exposed, live and die in Vegas, you’re about sixty-percent more likely than residents elsewhere in the United States to die by suicide. For the second model that you spoke of, the visitors coming to Las Vegas, compared to people who are staying home, it’s about a hundred percent increase in suicide risk. And for the residents of Las Vegas who leave, what we kind of think of as reduced exposure model, or a hiatus model -- you take a break from Vegas -- your risk goes down about twenty-percent.

DUBNER: So, it sounds like if you live in Las Vegas and there’s some chance that you may be suicidal, if you are depressed and you may be suicidal …

WRAY: Get out of town.

DUBNER: So, it really does, it really will help?

WRAY: Well, again, the over all risk here, this is important to keep in mind when we're using these particular measures, is really small.

DUBNER: But, but still what you’re saying is really interesting. You’re saying that the people who are there do it more regularly than any other city in the U.S., but also the people who don’t live there and come there then do it more often. So, I was going to ask you does this mean that Las Vegas is suicide-ogenic, that it actually causes suicide? Or is it maybe a suicide magnet? But it sounds as though from what you’re telling me that it’s very much both. Is that right?

WRAY: That’s what I believe. I can’t answer that definitively. I don’t have solid evidence on all sides of this question, but yeah, that the explanation that I think is most compelling. That there’s a chance that suicide rates are higher in Vegas in part because suicide rates are higher. That is, people are aware of this as a kind of more frequent option in Vegas. There’s a little bit of perhaps a Golden Gate Bridge-effect, where people also are recognizing Las Vegas as a kind of suicide destination. Now, I’ll point out that in absolute numbers, the number of people that are doing this is really quite small, we’re talking about twenty-five or thirty people a year who are visitors to Las Vegas who kill themselves there. But still that sounds like a small number, but that’s still a much higher number than we see in other cities.

DUBNER: Coming up… What is it about Las Vegas that leads to such a high suicide rate? We’ll also tell you why, if you live in New York -- like I do -- suicide isn’t at the top of your worry list. Here’s a hint: you might want to leave the cream cheese off your next bagel.

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ANNOUNCER: From WNYC and APM: American Public Media, this is Freakonomics Radio. Here's your host, Stephen Dubner.

DUBNER: Matt Wray is a sociologist who studies, among other things, suicide. He says there are quite a few factors that contribute to Las Vegas having a suicide rate that’s nearly double the national rate. For starters, it’s grown quickly -- really quickly -- from about 127,000 people in 1960 to nearly 2 million today. That kind of boom can make it hard to build strong government institutions -- and that, says Wray, can translate into a lack of services like psychiatric counseling. There’s also a high rate of drug and alcohol use in Vegas -- and, of course, there’s the gambling culture. But, Wray says, that’s not all.

WRAY: I’ll add that there’s one more feature here of Las Vegas, which I think bears mentioning, and that is what I kind of think of as a sort of "frontier culture" mentality among residents, and I think even among visitors that Las Vegas is just this sort of place of, of total license, you know? It’s the Wild West, it’s an open frontier for all kinds of immorality, and exploration of vice, and the entire self-branding of Las Vegas as this place where that is not only tolerated but actually sanctioned. You know the "what happens in Vegas stays in Vegas" kind of mentality produces I think a kind of Libertarian ethos of "go it alone, do it yourself..." Help-seeking in this framework is perhaps not kind of accepted or valorized the way it is in other parts of the country. These kind of cultural arguments are always very hard to make. They always sound deeply unscientific. But in a lot of ways, I think it’s exactly where a lot of the explanatory power comes from is understanding the culture, the values underlying people’s behavioral sets.

DUBNER: Let me ask you this, Matt, do you feel, as a scholar, I mean look -- you have what sounds to be a very nice job at a very nice university, in a very nice city, teaching sociology at Temple in Philadelphia, and you study suicide. And you study, as you put it, "losers," you know, people whose lives don’t turn out the way they wanted them to turn out, and then kind of need to ask themselves what do I do about it, and some of them kill themselves. In terms of that, do you feel that suicide is an underrated problem in our society and in any society?

WRAY: Underrated. Well I think that we’re kind of schizophrenic about suicide, which is that we have both devoted -- intellectuals, and scholars, and public health officials, and sociologists, and especially psychiatrists and psychologists -- have devoted so much ink to thinking, and talking, and exploring suicide that it’s hard to say that it’s, that it’s under-examined. We also tend to be obsessed with suicides in pop culture. I can’t even begin to list the number of films, the number of TV shows whose plot points turn on suicides, and so it’s kind of a hot-button issue. But I think it’s true, equally true, that most of the time we ignore the suicides that are happening in our midst. I certainly feel that’s the case in Las Vegas where every year or year and a half a reporter, an enterprising reporter at one of the Las Vegas newspapers discovers the suicide problem in Las Vegas, and we get a kind of rash of stories. And then we go back to not thinking about it. And so to the extent that we have this kind of look but don’t see relationship with suicide it is kind of under the radar.

DUBNER: Why do you think we have that relationship as a sociologist, or as a human being? We know it exists, it’s existed throughout history, the numbers are large. I mean, you talk about how predominant suicide is in pop culture, let’s say in TV shows or films. But I’ll tell you, without having done any looking into this at all, I'd bet a lot of money that murder is much more prominently featured in TV and on film than suicide. And yet murder takes fewer than have the number of live than suicide every year.

WRAY: Great point. We do seem to be far more focused on that form of violence than the lethal self-directed violence that is suicide. And I think that there’s a way in which the need for justice that we feel when a homicide occurs motivates us to take a greater collective interest in it. A crime has occurred. The most heinous kind of crime has occurred, a life has been taken, someone did it. That person is bad. We need to identify that person, and we need to bring about some justice and some retribution. Those ingredients are really missing. They’re really missing with suicide. We see it as tragedy; we see it as loss. It’s deeply saddening, and depressing, and grim. Very, very grim. And so, I think it doesn’t mobilize people in the same way that homicide does. Or even in some ways accidents.

DUBNER: Let me ask you one more question. I’d love…You mentioned it and I think we’re looking into it, so I’d love to know if you have any insight. What is the story with Hungary? Why such a, over a long period of history, why does Hungary have such a high suicide rate?

WRAY: You are absolutely right, Las Vegas has this high suicide rate. New York has the lowest. There are some urban counties in New Jersey that have lower, but the five-borough area in New York has extraordinarily low suicide rates. You know if you live in New York, an interesting thing is you are more likely to die of a heart attack than elsewhere in the United States. So the particular place-based risk of death for New Yorkers is not suicide, it’s a myocardial infarction. And so this speaks to the issue of how, sort of, place and health or mortality, you know, are related, which is one of the issues that I’m trying to get at in this study. In fact, the basic model for our Vegas paper was taken from a study in 1999 about the increase in heart attack risk that visitors to New York experience. People who visit New York see their risk for a heart attack go up by about six percent. And residents of New York have a heart attack risk that’s about twelve percent greater than elsewhere in the United States. So, you should get out of New York, because if you’re a New Yorker and you leave New York, Stephen, your risk of dying by heart attack will drop by about seven percent.

DUBNER: If I’m personally not at a lot of risk for a heart attack, then I can probably afford the added risk of heart attack by staying in New York. If however, I’m slightly more tending towards suicide, I got to stay out of Las Vegas.

WRAY: That’s exactly right.

DUBNER: And Hungary don’t even…

WRAY: Cancel that flight. Do not go if you are on the fence.

DUBNER: Freakonomics Radio is going to Hungary. And lots of other places, too. It’ll all be part of an hour-long episode about suicide that airs on finer public-radio stations this June. There’ll be four more hours of radio too. You’ll hear from Romanian witches, Harvard dropouts, and a couple of prostitutes. Oh yeah, a bunch of economists too.

I have to admit to a certain amount of prejudice. I live in northern Nevada – a place about as different from Las Vegas as it’s possible to be, yet all-to-often linked to it in many minds – and have seen a number of acquaintances move to Las Vegas and go nuts, so in some ways suicide seems a perfectly rational means of escaping that place.

However, a serious question: Las Vegas is perhaps one of the most artificially-constructed places around, and one which celebrates its deliberately-created separation from all aspects of the natural world. If we accept the biophilia hypothesis, this lack of connection should result in increased psychological problems, of which suicide would be one. So do we see similar increases in suicide rates in other deliberately non-nature-connected environments?

I have visited both Las Vegas and New Zealand, and have been struck by the trapped feeling that the remoteness gives you. LV is an island of decadence and plenty plunked down in miles of wasteland. NZ is a charming little place in miles of ocean. They are both smiley smiley tourist havens in the middle of…nothing. Living in either place would be very different from visiting there (I can say this holds true for NZ at least). Both places with high suicide rates and oddly high reported happiness rates. I don’t know about Vegas, but in New Zealand you are either part of the in-group or you are very much “out”, and if you do not integrate well with their cohesive society, you miss out on many benefits that improve your quality of life. There is also an awareness on the part of the people that a good impression of New Zealand has to be perpetrated in order for the island nation to survive, given that it depends on tourism and thus reputation. There is also the effort and money it takes to leave New Zealand if you decide you can’t go ON living there – a great deal, compared to other places you might want to leave. Housing is very expensive, and many people will sadly rent their whole lives, kicked by landlords from one house to another but never owning a home. That first rung on the property ladders is much higher than in other places, and even if you make it, the resulting debt with low wages can make for a pretty miserable, work-heavy, penny-pinching life. If you can’t get it together to leave (as many Kiwis do, across the Tasman, to find work in Australia), you are stucker than a stuck thing, struggling to keep afloat on an expensive island in the middle of nowhere. The drinking and cannabis use are through the roof in New Zealand as well, and for good reason. I imagine the service jobs in the Vegas hotels are fun, but don’t exactly propel you anywhere in life.

I’m surprised that it surprises you that murders are half as popular as suicides. Most people I know can talk of someone who offed themselves but knowledge of a murder would be very rare. I suppose murder is more natural in the purest animal sense but to a European it doesn’t feel it.

From what I’ve seen, there is a correlation for people with bipolar disorder with both gambling and suicide. That would imply to me that if you have a population with high rates of gambling addiction, then you are also probably going to have high suicide rates, because of a higher percentage of the population with bipolar disorder.

I have philosophical reservations about whether the state should intervene in someone’s end of life decision. If the state can’t intervene to prevent a person from having an abortion, then by the same logic the state shouldn’t intervene when you try to commit suicide. Even government assisted suicide makes sense, since many people commit suicide in an unsafe manner that puts other people at risk. The government could also require organ donation for suicides and design the procedure to maximize the organs that can be harnessed.

Interesting. If individuals judge their own sense of self worth by comparing themselves with neighbours, it might make sense that more people kill themselves in a thriving, generally happy place than in a poor, unhappy place. If everyone is miserable and poor, maybe there is a sense that the individual cannot take blame for his or her personal failures. But in a prosperous place the unsuccessful individual must face his or her failures.

Could the major factor be the lack of familiar ties? Compared to every other major metropolitan area Las Vegas has an extremely high percentage of residents who relocated from out of state. Less than a quarter of Las Vegas residents are from the state of Nevada.

Also while they have a much higher transplant rate than other cities they are also fairly far apart from any other major metropolitan areas. So while a lot of the “out of state” residents in other big cities might have family and friends within a 100-200 miles (an easy drive anytime one has a couple days off), there is not much population to draw from in the area surrounding Vegas. The nearest sizable population centers would be Los Angeles or Phoenix, both of which would be a 500-600 mile round trip. So even the transplants from “nearby” are probably too far away to visit family & old friends with any kind of regular frequency.

People without close family connections or long time friends would seem far more likely to be at high risk for suicide.